腹膜透析对重症急性胰腺炎细胞因子的影响

Clinical study of peritoneal dialysis treatment on severe acute pancreatitis

目的 探讨腹膜透析（PD）对重症急性胰腺炎（SAP）细胞因子的影响。方法2000年1月至2006年7月青州医院肾内科收治的48例SAP患者随机分为腹膜透析组（PD组）和非腹膜透析组（NPD组）。PD组运用腹膜透析技术对24例SAP患者进行腹膜透析治疗，NPD组运用常规治疗。比较两组的腹痛、腹胀缓解时间、CT积分、APACHEⅡ积分以及住院时间、住院费用、转手术率、并发症发生率和治愈率。比较两组血浆、腹膜透析液中TNF-α,IL-6，IL-8，IL-10和CRP细胞因子在治疗前后各时相点的含量。结果PD组及NPD组腹痛消失和腹胀缓解时间为（19．70±7．32）hvs．（81．46±36．68）h和（23．16±6．95）hvs．（78．19±29．26）h；两组比较PD组明显优于NPD组（P〈0．05）。治疗后PD组血浆中促炎细胞因子TNF-α，IL-6，IL-8和CRP在各时相点较NPD组显著降低（P〈0．05），抗炎细胞因子较NPD组显著升高（P〈0．05）。结论PD有利于纠正SAP早期促炎细胞因子过度释放和抗炎细胞因子失衡。且PD对早期SAP疗效显著，方法简单、费用低、创伤小、并发症少，值得进一步推广应用和研究。

Objective To ivevstigate the feasibitity, the effects and the therapy of peritoneal dialysis（PD） on severe acute pancreatitis （SAP）. Method From January,2001 to Jaly 2006,48 patients of SAP were divided randomly into PD group and non-PD group in Qingzhou hospital. Both groups were treated by the conventional mode of therapy. In PD group , using the concept of PD, 24 patients of SAP were treated with PD and NPD group were treated only with common therapy. The release time of abdominal pain and distention, CT scores, APACHE Ⅱ scores, the time of hospital stay, cost of treatment in hospital, operative rate and rate of complications and recovered rate of the two groups were compared. Simutaneously. the concentration of serum and fluid fihmted inflanunatory cytokines TNFα,IL-6,IL-8,IL-10 and CRP were also determined pro and post the therapy. Results In the PD and NPD group, the duration for disappear-ance of abdominal pain and tenderness, and amelioration for abdominal distension was （19.70±7.32） h vs. （81.46±36.68） h and （23.16±6.95） h vs.（78.19±29.26） h;So that the PD group was precede to that in NPD group （ P 〈 0.05）. The concentration of serum and fluid filtrated pronflammatory cytokines TNFα, IL-6, IL-8 and CRP at each observation points after PD was decreased significanfly （P 〈 0.05） in the PD group. But the concentration of the senma and fluid filtrated anti-inflammatory cytokines IL-10 was increased significantly （P 〈 0.05）as compared with that of the NPD group. Conclusions Through PD, the imbalance of pro-inflammatory and anti-inflammatory cytokines has been corrected at early stage of SAP. But the PD is method that is easy, quick, small wou-ndell, few complicated and effective in patients with early-phase SAP, and will be of great value in wide application and further study.